Provider Demographics
NPI:1023397502
Name:FORD, KIMBERLY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MARIE
Last Name:FORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 ELLICOTT MILLS DR
Mailing Address - Street 2:B2
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4500
Mailing Address - Country:US
Mailing Address - Phone:410-461-3311
Mailing Address - Fax:410-750-7348
Practice Address - Street 1:3505 ELLICOTT MILLS DR
Practice Address - Street 2:B2
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4500
Practice Address - Country:US
Practice Address - Phone:410-461-3311
Practice Address - Fax:410-750-7348
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD121841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice